'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

GPs condemn GMC's standard of proof plans

A decision by the GMC to strive to bring in a controversial new standard of proof for fitness to practise cases by next April has been widely condemned.

At its council meeting last week the GMC agreed to prioritise a change in its statutory rules to allow some fitness to practise cases to be adjudicated on the basis of the civil standard of balance of probabilities, as opposed to the current criminal 'beyond reasonable doubt'.

The timeframe came as the GMC set out its plans to respond to the Government's white paper on regulation and revalidation.

A Pulse campaign against the move to the new sliding scale of proof earlier this year gained more than 1,000 signatures and forced a partial backtrack by the Department of Health, which initially proposed that all cases should be decided on this basis.

At the council meeting, the GMC agreed to 'press the Department of Health to agree that the change to the civil standard of proof should be prioritised'.

Finlay Scott, GMC chief executive said: 'We will only switch to the civil standard of proof when we are confident we can deliver on our twin aims of enhancing patient safety and having processes that are clear and transparent.'

But Dr Peter Holden, a GPC negotiator, said he was horrified that the GMC – 'who are supposed to be elected by us and we pay their wages' – was pressing ahead with the move without further consultation.

'It's outrageous that my livelihood could depend on the balance of probabilities. I'm waiting to see what happens when the first doctor is unfairly deprived of their livelihood and sues the GMC. It will bankrupt them and council members will be personally liable.'

He predicted that the move would spark civil disobedience among doctors, who could refuse to pay their GMC fees.

Hugh Stewart, medicolegal adviser at the Medical Defence Union, also attacked the move. 'First and foremost it's unfair that someone's whole career can be decided on some undefined civic scale,' he said.

But he added that if the GMC was determined to go ahead they should produce more detail of how the system would work in practice. 'It has to be a fair and transparent procedure and it should include some public consultation.'

The issue is also set to provoke heated debate at the LMC conference in two weeks' time, with a number of LMCs submitting motions calling for the sliding scale to be dropped and slamming the leadership of the GMC, with some calling for an end to compulsory subscriptions.

Under its timeframe, the GMC plans to issue the first licences to practise to around 150,000 of the 240,000 registered doctors, by the end of 2008, although GPs may have to wait up to a further five years for revalidation under the terms of the white paper.

Mr Scott said: 'We are not committed to a specific timetable for revalidation. It is more sensible to issue licences and bring them into force first.'

The GMC's decisions

• Aim to bring in new sliding scale standard of proof by April 2008

• Introduce new licence to practice to 150,000 doctors by the end of 2008, whether or not new Government legislation on revalidation has gone through

• Press ahead with collecting ethnicity data on all doctors, with questionnaires likely to go out with surveys to collect scope of practice data; likely to be extended to include other equality data so the GMC can monitor whether certain groups are subject to more complaints

GMC under fire from GP over lower, civil standard of proof GMC under fire from GP over lower, civil standard of proof